Healthcare Provider Details

I. General information

NPI: 1215925870
Provider Name (Legal Business Name): CENTRO RADIOLOGICO DE ISABELA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4 CALLE MUNOZ RIVERA
ISABELA PR
00662-3006
US

IV. Provider business mailing address

PO BOX 946
ISABELA PR
00662-0946
US

V. Phone/Fax

Practice location:
  • Phone: 787-872-4888
  • Fax: 787-872-8181
Mailing address:
  • Phone: 787-872-4888
  • Fax: 787-872-8181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0206X
TaxonomyMammography Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GILBERTO RODRIGUEZ-SANTIAGO
Title or Position: OWNER/MEDICAL SUPERVISOR
Credential: M.D.
Phone: 787-872-4888